Methotrexate (MTX) for Early
Abortion

Methotrexate (MTX)
is a chemotherapy agent that has been used for many years in the treatment of
cancer because it affects cells that are rapidly dividing. In a Methotrexate (MTX)
Abortion, it stops embryonic cells from dividing and multiplying and is a non-surgical
method of ending pregnancy in its early stages.Within a few days or weeks of receing
an injection of Methotrexate (MTX) at the clinic the, the pregnancy ends through
an experience similar to an early miscarriage.

Methotrexate is a FDA approved
drug, but is not labeled for use in the termination of pregnancy. It has been
successfully used since 1982 in a single dose to treat ectopic (tubal) pregnancies
(where the fertilized egg is embedded in the fallopian tube instead of the uterus).
In 1996-97, FWHC participated in clinical trials with the University of Washington
to study MTX for Medical Abortion. The study showed MTX alone to be effective
and we continue to offer it as an option to women at our clinics.

Methotrexate
is given by injection the amount of which is individually calculated by each womans
weight and height. As the medication takes effect, MTX interferes with folic acid
and stops fetal cell duplication, and disrupts pregnancy at the stage of implantation
in the uterine wall. When given early in pregnancy, it is effective in ending
the pregnancy. (If a pregnancy were to continue after taking this drug, the fetus
has a high risk of deformities.)

The "miscarriage" after the
MTX injection occurs anywhere from two to six weeks later, when the uterus expels
the fetus. Passing the tissue is unpredictable. It may occur any time, day or
night, any place.

Side Effects

There
is limited information on childbearing after taking Methotrexate. Since the medication
works on dividing cells and a womans eggs do not divide until they are fertilized,
future pregnancies should not be affected. However, to be extra-safe, women should
avoid getting pregnant by using birth control for at least three months after
receiving Methotrexate.

When used in early pregnancy Methotrexate safely
and effectively induces abortion 90-97% of the time. Women who have chosen a medical
abortion said it felt more private and natural than a surgical procedure. If the
medication does not induce termination, a surgical suction abortion will be performed
at no additional charge. Medical abortion with Methotrexate (MTX) is an option
up to six weeks measured since last menstrual period (LMP).

Possible side-effects
of Methotrexate include nausea, vomiting, diarrhea, abdominal cramping, sores
in the mouth, headache, dizziness, insomnia, and vaginal bleeding. Except for
nausea, these side effects are unusual for the single dose given to induce abortion.

Risks

Vaginal
bleeding during the miscarriage caused by MTX may be heavy. In rare situations
it could require a surgical abortion and very rarely, a blood transfusion. If
a minor under age 18 has complications, their confidentiality cannot be guaranteed
as their parents or guardians may need to give consent for care if complications
occur.

Studies show MTX abortion has a failure rate of 1-10%. If spontaneous
abortion has not started by 6 weeks after injection, a surgical abortion is required.

Eligibility for MTX at FWHC

Less than six weeks gestation by ultrasound

Willing and able to give
informed consent

Have access to reliable transportation and telephone

Live
no more than two hours from emergency medical care

Agrees to come back
to the clinic for two to three follow up visits

Agrees to have surgical
abortion if the drug does not induce termination

Agrees to avoid sexual
intercourse until abortion is complete

MTX
Medical Abortion is not recommended for women with

History
of hepatitis, liver, kidney disease or inflammatory bowel disease

HIV
positive status

Abnormal blood profile and/or severe anemia

IV drug user

Known containing folate deficiency

Known intolerance
or allergy to Methotrexate

No telephone, no transportation

Living
more than 2 hours away from emergency medical care.

RU-486, the French Abortion Pill, Mifepristone is another medication used to
cause an early medical abortion. It has been used in the United States in clinical
trials at a few selected
sites. Soon it is expected to be approved by the FDA (Food and Drug Administration)
for widespread use in the U.S.

Published
in the Archives of Family Medicine, the study found that many of the women "found
the miscarriage-inducing method less invasive than surgery." Study author
Beverly Winikoff of the Population Council in New York said, "Even a large
percentage of women for whom the method failed said they would try [the two-step
oral prescription method] again if needed and that they would recommend it to
a friend or relative. Our trial results accord with previous research findings
that early medical abortion is desirable to the women who choose it," Winikoff
said. She added, "[W]hen asked why they had chosen medical abortion, women
in this study assigned great importance to avoiding invasive surgical procedures
and to an experiential quality of the method that women consider natural."

The
2,121 American women in the study followed the oral mifepristone-misoprostol regimen
that is standard in France. All participants were 63 days pregnant at most. Half
of the women had previously had surgical abortions. Seventy-seven percent of that
group "rated the medical abortion with pills more satisfactory." Although
almost all of the women said the method had been adequately explained through
counseling, almost half said their experience differed from what they had expected;
two-thirds said the experience was better than they had expected.

When
asked, both the women and providers participating in the study endorsed the feasibility
of home administration of the method, as some women found the three clinic visits
required by the method difficult to manage. Winikoff said, "If misoprostol
is used at home, specific counseling about what to expect in the hours after self-administration
and the availability of a 24-hour telephone support line may help allay women's
concerns."

On Wednesday June 24, 1998, the U.S. House
of Representatives passed the Coburn amendment, prohibiting FDA funding for approval
of mifepristone and other drugs that cause abortion, by a close vote of 223 to
202. The Coburn amendment, which was attached to an agricultural bill, threatens
FDA approval of mifepristone (known in Europe as RU 486). Similar language will
be considered in the Senate.

Mifepristone, which is available to women
in France, Sweden, and Great Britain, and is currently undergoing preliminary
testing required for FDA approval. The Coburn amendment would ban the FDA from
approving the production of mifepristone.

This affects several treatments
besides abortion -- Mifepristone's other potential non-abortion uses such as a
contraceptive, emergency contraception, endometriosis, fibroid tumors, meningioma,
Cushing's Syndrome, and labor induction, would also be hindered.

more:

Ibis Reproductive Health and the Population Council are pleased to announce the launch of a Spanish version of http://www.medicationabortion.com/, a multi-language website dedicated to medication abortion. http://www.medicationabortion.com/ is designed to provide accurate information about medication abortion to health service providers including physicians, nurse practitioners, physician assistants, counselors, and office staff. Educational information is also provided for women considering the option of medication abortion. http://www.medicationabortion.com/ is also available in English, French, and Arabic.

www.earlyoptions.org
- the new early options abortion pill, Mifeprex, was approved by the FDA in October
2000 and will be available soon throughout the USA.

"Women
are endowed by nature or god with the responsibility for babies. I believe women
are endowed by nature and god with the right and responsibility of choice about
abortion. It's an inherent right given to women by nature. It's equal in weight
to any other human's right to life."